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The effects of English proficiency on length of stay after isolated cardiac bypass surgery Tang, Erin Wei-Man

Abstract

Nurses often face the challenge of communicating information to patients who may not fully understand English. Limited English proficient (LEP) patients are at higher risk of misunderstanding health teaching, leading to impediments in their recovery. This study examined whether LEP patients have a prolonged length of stay (LOS) following coronary artery bypass graft (CABG) surgery when compared with English proficient (EP) patients. The study also compared the LOS of the two groups of patients (LEP and EP) with the study hospital’s clinical pathway target. A retrospective chart audit was conducted of all patients undergoing isolated CABG, over a two-year period. A screening tool was administered to determine each patient’s English proficiency based on documented information. A data abstraction tool collected pertinent pre-, intra-, and post-operative health indicators. 691 (97.1%) of the 712 charts reviewed were eligible for inclusion. The “limited or not English proficient” (LEP/NEP) patients had a median post-operative stay that was one day longer than that of the EP patients (7 days versus 6 days, p = .007). The median LOS stay of all patients, irrespective of English proficiency, exceeded the clinical pathway target of 5 days. In an unadjusted polynomial regression model, the LEP/NEP patients were found to be 2.2 times more likely to have a LOS of 9+ days (95% [CI 1.5, 7.2]). The multivariate model revealed that post-operative infection was the strongest predictor of LOS, and language proficiency was no longer statistically significant. Post-operative infections fully mediated the relationship between language proficiency and LOS. Relative to having a < 6-day LOS, patients with infections had greater odds of staying longer: ORadj = 3.30 (95% CI [1.51, 7.19]) for 6 days; ORadj = 4.37 (95 % CI [2.09, 9.14]) for 7-8 days; and ORadj = 12.4 (95% CI [6.03, 25.48]) for 9+ days. Higher infection rates were observed in LEP (29.1%) versus EP patients (16.7%) (OR = 2.05 (95% CI [1.27, 3.30])). The high infection rates suggest that further research is warranted to examine the mechanisms through which post-operative infections are acquired in CABG patients, and to better understand the role of language proficiency.

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Attribution-NonCommercial-NoDerivs 2.5 Canada